Levetiracetam-induced severe acute granulomatous interstitial nephritis

Chau, Katrina; Yong, Jim; Koçyiğit, İsmail; Griffith, Neil; Liu, Mengmeng; Makris, Angela

doi:10.1093/ckj/sfs023

Cited by 16 publications

(18 citation statements)

References 6 publications

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“…We performed a search of bibliographic databases and identified only eight studies, all case reports, that suggested a greater risk of AKI with levetiracetam (Supplemental Table 3). In these reports, four cases of AKI were attributed to interstitial nephritis, two to rhabdomyolysis, and one to a pharmacokinetic interaction with methotrexate (7)(8)(9)(10)(11)(12)(13)(14). Therefore, to provide additional safety data we conducted this population-based cohort study to determine whether levetiracetam use is associated with a higher risk of AKI compared with nonuse.…”

Section: Introductionmentioning

confidence: 99%

Population-Based Study of Risk of AKI with Levetiracetam

Yau

Burneo

Jandoc

et al. 2018

CJASN

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Background and objectives Regulatory agencies warn about the risk of AKI with levetiracetam use on the basis of information from case reports. We conducted this study to determine whether new levetiracetam use versus nonuse is associated with a higher risk of AKI.Design, setting, participants, & measurements This was a population-based retrospective cohort study of adults with epilepsy in Ontario, Canada. Patients who received a new outpatient prescription for levetiracetam between January 1, 2004 and March 1, 2017 were matched to two nonusers on stage of CKD, recorded seizure in the prior 90 days, and logit of a propensity score for levetiracetam use. The primary outcome was a hospital encounter (emergency department visit or hospitalization) with AKI within 30 days of cohort entry. Secondary outcomes were AKI within 180 days and change in the concentration of serum creatinine. We assessed the primary outcome using health care diagnosis codes. We evaluated the change in the concentration of serum creatinine in a subpopulation with laboratory measurements. ResultsWe matched 3980 levetiracetam users to 7960 nonusers (mean age 55 years, 51% women). Levetiracetam use was not significantly associated with a higher risk of AKI within 30 days (13 [0.33%] events in levetiracetam users and 21 [0.26%] events in nonusers [odds ratio, 1.24; 95% confidence interval, 0.62 to 2.47]). Similarly, there was no significant association with AKI within 180 days (odds ratio, 0.70; 95% confidence interval, 0.43 to 1.13). The change in the concentration of serum creatinine did not significantly differ between levetiracetam users and nonusers. ConclusionsIn this population-based study levetiracetam use was not associated with a higher risk of AKI.

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Section: Introductionmentioning

confidence: 99%

Population-Based Study of Risk of AKI with Levetiracetam

Yau

Burneo

Jandoc

et al. 2018

CJASN

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“…5 To our knowledge, there are only three reports of LEV-induced acute kidney injury in adults; in all of which, deterioration of renal function appeared in the first few days or weeks after starting treatment with LEV and was completely resolved after stopping the drug. [6][7][8] Moreover, the improvement in renal function in our patient was initiated before LEV withdrawal. In the case described by Spengler et al acute renal failure with creatinine 2.76 mg/mL was observed only one day after administration of a dose of LEV of 1,000 mg in a 23-year-old woman (Table 2), with a CK peak value of 1,368; this is the only case described with both adverse effects simultaneously.…”

Section: Discussionmentioning

confidence: 86%

“…6 Chau et al treated a 69-year-old woman who presented severe granulomatous interstitial nephritis whose manifestations began 14 days after beginning treatment with LEV. 8 There is a single paediatric case report of severe LEV-induced interstitial nephritis. 9 In our case, rhabdomyolysis was not the cause of deterioration of renal function, bearing in mind that it appears with CK values usually above 5,000 U/L; far above those presented by the patient.…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury and Creatine Kinase Elevation After Beginning Treatment with Levetiracetam

Mena-Martin¹,

Gutierrez-Garcia²,

Martin-Escudero³

et al. 2018

European Neurological Review

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Levetiracetam (LEV) is one of the most common anti-epileptic drugs available. In general, it is tolerated relatively well; the majority of adverse effects are moderate and normally occur during the initial titration. We present a patient who developed two moderately serious adverse effects after an initial LEV dose: a 28-year-old male was admitted to intensive care unit after suffering two generalised seizures, and was given 1000 mg of LEV. Twenty-four hours after admittance, the laboratory tests showed a serum creatinine of 2.84 mg/dL and creatine kinase (CK) of 421 U/L (normal, 0171 U/L). At all times the diuresis was normal, with a maximum value of creatinine of 4.67 mg/dL 48 hours following admittance, and the CK values ranged between 421681 U/L with proteinuria of 840 mg/day. On the seventh day, blood tests showed a CK of 1,559 U/L and a creatinine of 1.55 mg/dL. LEV was progressively substituted for lacosamide, after which creatinine, CK and albumin excretion rate were normalised. Thus, CK and renal function during treatment with LEV should be monitored, and acute kidney injury due to LEV should be considered in the differential diagnosis for any unexplained acute renal failure.

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“…Other case reports of NSAIDs-induced GIN have been published with good results following drug discontinuation and corticoid therapy 21 22. Cases of GIN induced by other classes of drugs have also been described, with good results following the same line of treatment 23–25…”

Section: Discussionmentioning

confidence: 99%

Granulomatous interstitial nephritis: a rare diagnosis with an overlooked culprit

Figueiredo¹,

Rodrigues

Sousa

et al. 2019

BMJ Case Rep

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Granulomatous interstitial nephritis (GIN) is a rare entity identified in <1% of native kidney biopsies. The most frequent aetiology is drug-related, followed by systemic granulomatous conditions. Among drugs implicated in GIN, antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequent. We report the case of a 45-year-old white man referred to a nephrology consult due to chronic kidney disease. He had a history of arterial hypertension with 10 years of evolution, hyperuricaemia, medicated with allopurinol and NSAID abuse for at least 20 years. Urine sediment was blunt, without proteinuria. Renal ultrasound was normal. A kidney biopsy revealed well-defined epithelioid granulomas with glomerular wrinkling and collapse. Infectious and systemic conditions were excluded, favouring the hypothesis of drug-induced GIN, probably related to NSAIDs. Kidney biopsy remains the gold standard for the diagnosis of GIN. Facing a patient with renal failure without significant proteinuria or active sediment, one should look for causes of tubulointerstitial injury.

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Levetiracetam-induced severe acute granulomatous interstitial nephritis

Cited by 16 publications

References 6 publications

Population-Based Study of Risk of AKI with Levetiracetam

Population-Based Study of Risk of AKI with Levetiracetam

Acute Kidney Injury and Creatine Kinase Elevation After Beginning Treatment with Levetiracetam

Granulomatous interstitial nephritis: a rare diagnosis with an overlooked culprit

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